Individual provider Active NPI

Jon Brian Roberts

  • Surgical Critical Care Physician
  • Bend, OR
National Provider Identifier
1568696235
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
MD177896 Issued in OR
Practice address
2200 NE Neff Rd Ste 302
Bend, OR 97701-4279
Phone
(541) 706-6915
Fax
(541) 706-6733
NPI assigned
May 11, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD177896 OR
Surgical Critical Care Physician 2086S0102X MD177896 OR Primary

Addresses

Primary practice location

2200 NE Neff Rd Ste 302
Bend, OR 97701-4279

Mailing address

60 Haven Ave Apt 24D
New York, NY 10032-0572
Phone (503) 449-0442

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jroberts17945@secure.stcharleshealthcare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160915001921 OR Practitioner - Other (Physician)Practitioner - General Surgery 3375839426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Undefined Physician Type (Specify)Also: General Surgery
Education
Columbia University College of Physicians and Surgeons, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

1253 NW Canal Blvd
Adv Illness Manag
Redmond, OR 97756-1334
Phone (541) 706-5880

211 NW Larch Ave
Family Care
Redmond, OR 97756-1357
Phone (541) 548-2164

2500 NE Neff Rd
Bend, OR 97701-6015

655 NW Jackpine Ave
Sleep Cent
Redmond, OR 97756-1334
Phone (541) 526-6661

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD177896ORMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Sep 12, 2016 Accepting new patients
St. Charles Health System, Inc. CurrentSince Sep 12, 2016 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

2500 NE Neff Rd
Bend, OR 97701
Phone (541) 388-4333

2275 NE Doctors Dr
Ste 6
Bend, OR 97701
Phone (541) 389-3166

2200 NE Neff Rd
Ste 302
Bend, OR 97701
Phone (541) 706-4220

480 NE A St
Madras, OR 97741
Phone (541) 475-4800

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1568696235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 HAVEN AVE APT 24D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100320572",
            "telephone_number": "503-449-0442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD STE 302",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014279",
            "telephone_number": "541-706-6915",
            "fax_number": "541-706-6733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JON",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-11",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD177896",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "OR",
            "license": "MD177896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jroberts17945@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "2200 NE Neff Rd Ste 302",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977014279",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.